The aim of our proposed project is to produce a book that represents a synthesis of the recent two decades of research on hospital organizations and which contains a series of practical recommendations for those interested in improving hospital performance. Additionally, this book will summarize the current state of research on "what we now know" about hospital organization and contain a critical review of this research organized according to clearly identifiable "families" each with their own distinctive problem focus and methodologies. This synthesis will utilize the products we have recently completed under a contract with the National Center for Health Services Research, namely the detailed codings and abstracts of all empirical research on hospital organizations published during the 1970s. The proposed book will build upon the Georgopoulos review and resource book about the 1960s hospital organization research but will update and move beyond it in a number of ways. It involves a deeper integration of the field and its sub-families as well as a more explicit effort to provide implications and recommendations. The synthesis and book will be organized around the impact of organization structure and management process on four critical hospital performance variables: quality of care, cost efficiency, morale/turnover, and innovation. A contingency perspective will stress the importance of type of hospital contingencies such as size, technology, and control/market environment. The last three chapters of the book will provide a synthesis and set of recommendations directed at three separate audiences: researchers, hospital administrators, and policy makers. Given the disparate nature of the hospital organization research field and the radical increase in health care costs, the central role of the hospital in the health care system, and problems of nurse turnover, the need for such a synthesis and derived recommendations is considerable.